This post is from The King's Fund Blog
‘It’s not about gadgets, it’s about service redesign.’
I’m paraphrasing a little, but this was the message from NHS Improvement Programmes’ Director Bernard Quinn at a recent digital health conference. Bernard’s team is already hard at work making that transformation happen: NHS Improvement’s Digital Outpatients programme is hoping to bring £3 billion of benefit from digitising the process of booking and receiving an outpatient service where possible.
If you’re interested in the use of digital technology within the NHS in England, you’ll know that it can be a case of ‘haves’ and ‘have-nots’. Some regions are beginning their digital plans at pace, others are already enjoying the benefits of integrated care records or real-time analytics, while some still struggle on with Windows XP.
So where does this variation come from? And do we have an opportunity now, in the sustainability and transformation plan (STP) process, to make significant progress with digital services?
There has been some uncertainty around the future of digital technology in NHS policy over the past 18 months, with changes in leadership at NHS England and the Department of Health, the waiting game around publication of the Caldicott review, and the focus on organisational pressures created by rising demand at a time of constrained resources. On top of this, the Local Digital Roadmap process (the separate planning process for the ‘Paperless 2020’ programme) was already underway before the beginning of STP planning, but one process needs to be integrated into the other.
Despite these challenges, the STP process provides an opportunity for place-based digitally enhanced care using shared, integrated records across primary and secondary care to start to become a reality. For the first time in years in some areas, the key organisations in health and care have sat down together to form a single vision for care in their region, and digital technology can be a key part of that.
This isn’t the beginning of digital work and learning within the NHS. There are some great examples of care being delivered in new, more convenient (for both patient and clinician) and efficient ways, making use of better integrated systems and shared data – you can see plenty of examples in our map of technology and data in health and care. Here at the Fund we work with a number of digitally-focused organisations in the private sector – from SMEs through to multinationals – many of which are investing in innovative digital health programmes. The Richmond Group of Charities has published a collection of case studies that show demonstrable benefit through better use of data to improve health and wellbeing. If you merged all the innovation and learning that has come from improved information for both provider and patient across England into one area, you’d have probably the finest digitally engaged health care provider in the world.
However, in our briefing on digital technology we highlighted the need for a clear and definitive plan for digital services in the NHS. Leadership is needed to provide guidance and support for digital developments that are part of the STP process. A delay with no additional funding leaves local management in an uncertain place, unclear about what will and won’t be funded.
Extra funds were hinted at earlier this month, only to be taken away again immediately. We know that the Department of Health has set aside £4.2 billion over the next five years to provide additional funding for digital technology projects, but it’s still not clear exactly what sort of projects will be prioritised. ‘Paperless by 2020’ is still the official target for the Department of Health, but what does that mean for app usage or wearable technology?
As the digital roadmap for North West London states: ‘[Our plan] identifies a significant need for central funding for technology, but it is not yet clear how much funding will be available and when, or on what basis it will be distributed, so it is difficult to plan.’
To let local areas decide what they’re best placed to achieve in the coming years with digital technology is a move in the right direction; to allow that innovation to develop while avoiding some of the mistakes of the past. But what will and won’t be funded is still unclear at a time when the Department of Health’s capital budget is being eyed up for revenue contributions for year-end accounts.
There are plenty of success stories though: the Wachter Review was clear that the key to a successful IT programme is not a diktat from governing bodies backed up by a wave of investment, but rather the harnessing of innovation and passion for digital services that lies dormant within many organisations. A willingness to take risks backed up by early clinical engagement (or clinicians and care staff feeling able to create new ways of working) and a collective vision within a trust is a common theme between digitally outstanding areas.
But this isn’t just about replicating what others have done: innovation is perhaps the most exciting aspect of digital technology. Presenting the opportunity to be a part of new, pioneering work to those at the front line is not just a key recommendation of the Wachter Review, but also a practical way to engage a stressed and stretched workforce with new, positive work. That contrast between ‘haves’ and ‘have-nots’ mentioned earlier isn’t just about internal business processes and efficiency. It’s also about the amount and quality of care that trusts that are not as digitally capable can deliver.
Currently, there is a perceived lack of support for digital innovation from the government (at a recent conference a senior policy-maker in the digital team of a central body told an entire room ‘Putting a new computer system in place at a hospital is a bit of a hassle really’). Unless NHS England and the Department of Health can provide the vision and support the NHS needs, it might be up to local areas to create new digital systems that they can benefit from for years to come with whatever resources they can scrape together themselves.